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Introduction Section

WELCOME TO THE AZUSA PACIFIC SWIMMING QUESTIONNAIRE!!!

Questionnaire Code
(not required):

Personal Information

First Name:

Middle Name:

Last Name:

Preferred Name:

Country:

Address Type:

Street Address:

City:

State:

Zip:

Grad Year:

Date of Birth:

Email Address:

Home Phone:

Mobile Number:

FaceBook:

Twitter:

@

Instagram:

@

What is your connection to this university:

Parent(s) Information

Parent 1's First Name:

Parent 1's Last Name:

Parent 1's Gender:

Parent 1's Address (If Different):

Parent 2's First Name:

Parent 2's Last Name:

Parent 2's Gender:

Parent 2's Address (If Different):

Academic Information

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School Name:

School Address:

School City:

School State:

School Zip:

School Phone#:

GPA:

SAT Composite:

ACT Composite:

Intended Major:

Have you Joined the Eligibility Center?

Eligibility ID:

Club Information

Club Name:

Club Address:

Club City:

Club State:

Club Zip:

Club Coach:

Club Coach Cell:

Club Coach Email:

Events

Important: Once you select an event all fields for that event are required and
must be input correctly. If all fields are not filled out correctly then those values
will not be logged with your application.

Distance

Type

Best 1

Best 1 Date

Best 2

Best 2 Date

Event 1

Event 2

Event 3

Event 4

Event 5

Event 6

Other Questions

Do you have any online video? If so please provide the link.:

When you have completed this questionnaire please click submit questionnaire.